CPAP for Obstructive Sleep Apnea

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Sleep apnea and snoring are the most common reasons for people to show up in a Sleep Disorders Center. These problems can range from being simple and uncomplicated to life threatening. Most people will snore at some point in their lives. Snoring in itself is considered a cosmetic problem, but the snoring can also be a sign and symptom of a deeper problem: sleep apnea. Sleep apnea is when you stop breathing while you are sleeping.

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There are different types of sleep apnea but the most common is obstructive sleep apnea, or OSA. OSA occurs because there is a physical obstruction in your airway preventing you from getting enough air while you sleep. It could be large tonsils or a large tongue. It could be polyps in your nose. It could be you have a jaw that recedes back a little. A bad cold, allergies, a little alcohol, or being overtired will all compound the problem. You may breathe okay while you are awake, but once you fall asleep, relaxation of your airway causes it to either collapse completely or narrow enough to cause problems getting enough air.

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Breathing is something so natural most people don't eventhink about it and once you are asleep you probably have no idea what you are doing. As a sleep professional, we often rely on bedpartners or housemates to tell us what they see (and hear) is going on once you fall asleep. If you have been sent for a sleep study and we see you are having pauses in your breathing or a reduction in airflow you may be introduced to CPAP, which stands for Continuous Positive Airway Pressure.

Many people who come to a sleep lab for sleep studies have what is called a "split study". A split study means that half the night is diagnostic (we will see if you have at least moderate sleep apnea) then the last half of the night is treatment (with CPAP). If the technologist (me) sees that you qualify by having at least 15 disordered breathing events per hour, then I will come in, usually after 2-3 hours of watching you sleep and start up the CPAP. It is like a breath of fresh air for people who need it.

You will have already been pre-fitted with a CPAP mask that is comfortable for you to wear. This is the most important part of the whole procedure: if you aren't comfortable with your mask you will not want to use the CPAP. There are a variety of CPAP masks to choose from so if you and your technologist are determined, you can usually find one that will work for you.

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Once you are fitted with a mask, the technologist will start up the air. The air acts like a splint in your airway to prevent it from collapsing. We will start out with a low pressure. Normal atmospheric pressure is around 3.5 cm H20, as measured with a water hydrometer, we will start out just a little above that. I like to start at 5 or 6 cm H20. I find that some people feel like they aren't getting "enough air" at the lower pressures so I always tell my patients to let me know if they are comfortable. We will start out where you are comfortable and then work from there. There are different settings that we can use to make it feel more comfortable, so it is very important to have good open communication with your technologist. This can be a little bit tricky with the CPAP on with the air going, because it can be hard to talk with it on, but with patience and relaxation we can usually figure out a good starting point to help you fall asleep.

Once you fall asleep you may need a higher pressure on the CPAP. Your technologist will raise the CPAP pressure to eliminate snoring and pauses or reductions in your airflow. Once you are breathing again in all stages and positions of sleep, we have your "prescription". You will go to your follow-up appointment with your physician to get the order and you can pick up your CPAP mask and machine at a home-health agency or order online, it depends on your insurance company.

CPAP masks and machines and sleep studies are covered under almost all insurance policies, they recognize that treating your sleep apnea will improve your health in the long run.

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You may actually feel like a new person after only one night with CPAP so don't hesitate to try it.